When 2020, Florence Nightingale’s bicentennial year, was designated the first ever Year of the Nurse and the Midwife by the World Health Organisation, no one could possibly have imagined the extraordinary demands facing nursing staff this year. Celebrating nurses is hugely important given the well documented levels of burn out and stress reported globally, but recognition is just the start. What can be done to improve the day to day nursing experience?
The Institute for Healthcare Improvement (IHI) believes a big part of the solution is to focus on restoring joy to the healthcare workforce. But this is not just about big strategic changes; as the success of the 15s30m social movement (@15s30m on twitter) is showing, an individual making one small change can transform the day to day experience of one or more colleagues and patients, reducing frustration and improving joy. As Dan Wadsworth, Transformation Manager at TeleTracking International explains, small changes can have very significant results, not least in enabling far more time to care.
Staff Burn Out
Florence Nightingale’s heroic efforts on the battlefields of the Crimean War seem particularly poignant during the Covid-19 pandemic. Yet while medical advances over the past two centuries have transformed our ability to care, in recent years, time to care has been compromised by hugely frustrating administrative distractions. In celebrating the Year of the Nurse, it is time to refocus energies on reducing unnecessary, extraneous and often stressful activities and enable nurses to concentrate on delivering patient care.
This shift is essential if health services around the world are to address the damage caused by staff burn out. Long before the Covid-19 pandemic placed unimaginable pressure on nurses throughout the world, 50% more staff in the NHS were already reporting debilitating levels of work stress compared with the general working population, stress that affects both their well-being and patient outcomes.
According to the Kings Fund, the primary cause of that stress is excessive chronic workload; it is also the number one reason for clinicians to say they will quit. So what can be done to address this situation and, from a nursing perspective, release essential hours back to delivering patient care?
Small Actions, Big Impact
The IHI’s focus on joy in work has inspired a number of NHS-wide and Trust-wide initiatives; but small, local actions can have hugely significant results. One of the most important aspects of reducing frustration and achieving joy in work is enabling people to take control and make small, positive, immediate improvements that affect both their working lives and those of their colleagues.
Anyone on the front line of NHS services – from nurses to junior doctors, porters, healthcare assistants, cleaners and receptionists – is well placed to make such changes. They know the job inside out and understand day to day frustrations. They are in the position to step outside regimented processes and enable an immediate, if small, change that feels empowering and delivers real benefits to others.
This latter point is key, as research into clinical burnout suggests firstly, that is important to focus on just one or two things in a day that can be impactful for other people and, secondly, the importance of connection, belonging and support. Undertaking local activities that can support colleagues and helps to create a team is proven to lower stress levels.
This is very much the theory espoused by the 15 seconds, 30 minutes (15s,30m) social movement which uses the TARDIS model: something that can be done Today, takes only A little extra time, Reduces frustration, Doesn’t require permission, Increases joy and is easy to Share.
For example, one paramedic now asks every patient, if possible, whether they have their glasses with them before being taken to hospital. Takes seconds, sounds simple. But the impact for both patients and their clinicians will be significant throughout their stay in hospital – such as being able to keep themselves occupied reading books and take themselves to the bathroom rather than requiring assistance.
A similar small change within ED also saves time and reduces a patient’s wait for a bed. ED nurses requesting a porter to collect a patient have taken a couple extra seconds to note not just the ward but also the assigned bed. As a result, rather than leave the patient at a ward, where a nurse then has to take the time to check which bed has been assigned and move the patient, the porter can take the patient directly to the correct bed – better for both patients and nurses.
Reducing Idle Bed Time
Bed management is a prime example of extraordinary change that can be achieved with small actions. For the vast majority of nurses one of the biggest causes of interruption and frustration throughout the day is fielding constant phone calls and visits from bed management teams. With a live bed state across the entire health system and an automated process for updating patient discharges it can take a nurse just 15 seconds to mark five patients as potential or confirmed discharges.
The impact is huge – from saving time within the control centre when pre-assigning beds to waiting patients, to ensuring every patient is placed in the right bed, first time, every time. And with no phone calls or visits to disrupt essential caring activity, nurses also enjoy the benefits of reduced frustration and more time to care.
When patients are admitted and badged using a real time locating system, a Trust can track all patients from admission to discharge. Taking 15 seconds to ensure all patient badges are placed in a drop box on discharge can have a very marked impact – especially if a Trust has a dedicated bed cleaning team in place. As soon as a badge is placed in the drop box, an alert is triggered that automatically turns the bed ‘dirty’ in the system and a notification sent to the bed cleaning team. Once completed, the cleaners can use an app to confirm the bed’s availability for the next patient. The simple process of dropping the badge in the drop box has saved huge amounts of time, calls and chasing for other people and, by cutting idle bed time, has reduced patient delays.
It may seem strange to talk about joy in work at a time of huge Covid-19 related stress, but the fact is that small acts can have an enormous impact on the day to day experience of colleagues throughout the system. Indeed, as the NHS has flexed to adapt to these unprecedented demands, amazing changes are being achieved, changes that will have far reaching, positive implications for the way clinicians work in the future. From video consultations as standard to the transformation of outpatient services, reform and process change is being fast-tracked.
This is an ideal time for change – it is a time to eradicate frustrating and unnecessary administrative burden and it is also time to build better collaboration between teams, collaboration that improves joy in work and, critically, increases time to care. That, surely, should be the outcome of the Year of the Nurse.